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Background: The Central Coast Integrated Care Program CCICP is one of three integrated care demonstrator projects within NSW Australia funded for three years to challenge existing service fragmentation within and between health and social care sectors. The district-wide complex intervention focused on vulnerable youth, vulnerable older persons and people with chronic and complex conditions. As part of the formative evaluation of the CCICP, the Project Integrate Framework was used to map integrated care progress. This Framework provides an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation. Methods: Based upon the Project Integrate dimensions, an online survey of key stakeholders was undertaken. The survey results underpinned a workshop to assist CCICP team reflection and assessment of progress. This exercise enabled future program priorities and strategies to be set. Key stakeholder interviews were mapped to the Project Integrate dimensions for additional perspective. Results: The research results indicated where progress had been achieved, where learnings had been embedded in service delivery and aided the determination of priorities for action. Learnings about the suitability of Project Integrate dimensions and their use in online, interview and workshop formats will enable its use in other Australian and international settings. Discussion: The Project Integrate Framework aims to provide a conceptual basis for reflecting on the design and implementation of integrated care programs/projects. Our research found the survey tool alone was inadequate to assess integrated care progress, with many answers reflecting uncertainty Neither Disagree nor Agree. The data was reviewed in a workshop with the CCICP team to contextualise the uncertainty, particularly given the formative assessment stage. This greatly enhanced the understanding of progress in care integration on the Central Coast. This finding is congruent with the recommendation for the use of the Framework outlined in the original research. The Project Integrate Framework was identified by the CCICP team as a key communication tool, enabling a consistent terminology for integrated care. However, certain terminologies were not always understandable or meaningful to everyone. Group discussions were important to generate collective understanding of the meaning and importance of the dimensions. As with international case examples, progress towards system integration was regarded as poor, with substantial structural barriers beyond the control of the CCICP team. The intervention appears to be tracking more favourably in the dimensions of person-centred care, clinical and professional integration which was linked to sustained efforts to build relationships and enable a shared understanding of what the CCICP was seeking to achieve normative integration. Conclusion: Use of the Project Integrate framework supported by appreciative dialogue has enabled the CCICP team to reflect on progress and spread of integrated care within the Central Coast Local Health District and on what should be their next steps for spreading and building sustainability. The research findings are being used to refine the Project Integrate Framework as a means to support on-line assessments of integrated care to enable programs to have meaningful group discussions on design and implementation, and as a means to facilitate comparative research. [ABSTRACT FROM AUTHOR]

Background: The Project Integrate[i] conceptual framework began with a literature review on conceptual frameworks and relevant aspects of integrated care, from which a new conceptual framework, was built iteratively. This framework provides a standard set of dimensions and sub-elements which can be used to describe any integrated care initiative. As part of the formative evaluation of the Central Coast Integrated Care Program (CCICP), we have employed the Project Integrate Framework to map the integration efforts of the program, provide a consistent and common language, to enable supported self-assessment of progress towards integrated care and to allow for international benchmarking. Methods: An online survey of key stakeholders was undertaken mapping the degree of agreement on progress towards the Project Integrate dimensions. The survey results were used as a support tool in a workshop to assist CCICP team reflection and assessment and build a situational analysis of care integration progress within the program. This exercise was used as the basis to support agreement of future priorities and strategies within the program. Results: The survey results indicated where progress towards care integration had been achieved in the Central Coast. It was then used as a support tool in a workshop setting to assist the CCICP team to reflect and self-assess progress towards integrated care. Reflections regarding international comparators were made, stimulating further discussion, this led to the recognition of progress made to date and a realistic review of where progress should be given the maturity of the intervention. Achievements and opportunities were identified, with priority areas mapped out. A key priority was communication, in particular, building a common and consistent language for integrated care. Workforce and upskilling regarding data warehousing and analysis was also identified as an opportunity for future work. Di scussion: The survey tool alone was inadequate since many answers reflected uncertainty regarding progress (Neither Disagree nor Agree), thus the data required review and further consideration by the team to contextualise the uncertainty, particularly given the formative stage of assessment. The power of the survey results was in the group analysis and the contextualized discussion which ensued and added greatly to the understanding of progress in care integration on the Central Coast. The Project Integrate Framework and its nomenclature was identified by the CCICP team as a key communication tool, to build a consistent terminology for integrated care and its use in reporting, communication and stakeholder engagement. As with international case studies, progress towards system integration was regarded as poor, with substantial structural barriers beyond the control of the CCICP team. However, the intervention appears to be tracking more favourably in the dimension of patient-centred care. Conclusion: Use of the Project Integrate framework has enabled the CCICP team to reflect on progress and spread of integrated care within the Central Coast Local Health District and where their next steps should be for spreading and building sustainability. [ABSTRACT FROM AUTHOR]